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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: <br /> <br />CERTIFICATE OF INSURANCE . <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br /> <br />PRODUCER: PUBLIC ENTITY (ADDmONAL INSURED) <br />Driver Allia!1t Insurance Services CUy 06 san:ta. Ana <br />P. O. Box 28323 20 Civic. CenteJt P.f.aza, M-28 <br />Santa Ana, CA 92799-8323 San:ta. Ana, CA 92701 <br />(949) 660-8163 , <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOIDER): I EVENTINFO~TIBli . nat e1.6 <br />,..; - lXoo1-/.33 TYPE: n.6 mo -S ImplWvement <br /> DATE(S): I/Ub/U~ IZ/"IU~ <br />Leticia QUVl.OZ LOCATION: S.A. JaM: <br />. <br />This is to certify that the policies of insuIaDcelisted below have been issued to tbe insured named above for tbe policy period <br />indicated. NotwitbstaDding any req.w.~ull., tenns or conditions of IDY coDlracl or other ~t with respect to which this <br />certificate, may be issued or may pertain. tbe insuIaDce afforded by tbe policies descnbed herein is subject to all tbe tenns, <br />exclusions and c:onditioos of such policies. Limits shown may have been Ieduced by paid claims. . <br />INSURANCE CARRIER: Evanston Inswance Company <br />MASTER POLICY NUMBER: OsSEPlOOOOO1 <br />MASTER POLICY DATES: EFFECTIVE: JANUAR~ 1, 2005 EXPIRATION: JANUARY 1,2006 <br />COMMERCIAL GENERAL LlABIUTY OCCURRENCE FOIlM DEDUCTmLE: NONE <br />GeueraI AaJqalc Limit S 2.000.000 <br />Produc1s &. c:on.>IeIed Opontioos 1.000.000 <br />PaaonoI &. AAhatisi..lnjUIY 1.000.000 <br />Each Occurnmcc Umit 1.000.000 <br />FiR JJomose (Any One Fire) 50.000 <br />Medical Payments (Any One Persoo) 5.000 <br />The limits ofin......... apply .-ntely lo oach ....t inIured by thi. poIic:y as if. -'" policy of insurance.... been illUed fw1hat....L <br />"Who i. _" is amended to include,.. an _.the person ... orpnlzadan shown in tlris schedule, but only with respect to liability arisins oulofthe <br />ownership. maintcoanc.... ... of the premises UJOd by the named insured (event hold...~ This insunnce daes 1101 apply to: Any "occurrence" which...... place <br />_ the....t holder _ robe . tenant in 1hat pmni-. <br /> OTHER ADDmONAL INSUREDS <br /> , <br />CA~' I A noN: Should Ihc 8bove descrjbed policy to ClllCdlcd before the expiration date thereof. the issuing company will mail 30 days wriuen notice to the <br />certificate holder and addftional insureds listed. <br /> <br />AUlHORlZED REPRESENTATIVE: <br /> <br />~;Z~ <br /> <br />""t <br /> <br />DATE ISSUED: <br /> <br />Janu.aJty 6, 2005 <br /> <br />~V'(Af <br />,.....'. 1 <br />